Improving Shoulder Dystocia Outcomes With Teamwork and Deliberate Practice [26S

Abstract

INTRODUCTION: The management of shoulder dystocia requires coordinated time-sensitive teamwork. A complication of performing the posterior arm delivery is neonatal humerus fracture. The study objective was to determine the effectiveness of teaching shoulder dystocia management using simulation aimed at teamwork and communication, with a focus on deliberate practice of posterior arm delivery skills. METHODS: A prospective pre/post educational study design was used to assess effectiveness of a curriculum designed for labor and delivery personnel using simulation for the coordinated team management of shoulder dystocia. A portable task trainer was used to practice safe delivery of the posterior arm including inserting the provider hand on the side of the fetal chest and splinting of the humerus. Outcomes were measured using performance assessment scores, safety culture surveys and the rate of neonatal humerus fractures in shoulder dystocias over one year. Internal review board exemption was obtained. Paired t-tests and repeated measures were used for data analysis. RESULTS: Teamwork drills were held with 166 multi-disciplinary participants in a large obstetrical hospital over one year. Statistically significant improvement occurred in knowledge (pre 64.01%, post 94.22%, p<0.0001), performance (pre 61.83%, post 92.86%, p<0.0001) and safety culture surveys (pre 3.27, post 1.57, p<0.0001, 1=high, 5=low). Compared with the year prior to the study, the rate of neonatal humerus fractures in shoulder dystocias was reduced by 42.86%, (pre 5.51%, post 3.88%, p<0.0001). CONCLUSION: Simulation training improved teamwork performance during shoulder dystocia emergencies. Deliberate practice of posterior arm delivery skills significantly reduced the rate of neonatal humerus fractures.